NCG060351 DMR SW (5)

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Cy ality General Permit No. NCG060000 RECEIVED
Date submitted /
CERTIFICATE OF COVERAGE NO.
FACILITY NAME \A) r X.
COUNTY O- t 4rW---
PERSON COLLECTING SAMPLES-
LARORATORI . c,11 4Q.4ex,,4_7
'iy
Lab Cert. #
Part A: Stormwater Benchmarks and Monitoring Results
AUG 10 2015
SAMPLE COLLECTION YEAR �r' S�
FACILITY' ACTIVITIES INCLUDE (check all that apply): CENTRAL FILES
❑ use/process meats ❑ use animal fats/byproducts SECTION
DISCHARGING TO SALTWATERS? [-]YES ONO
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event roinfoll01-I or ❑ No discharge this period'
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH, COD,
Standard units mg/L
Oil and Grease,
mg/L
Fecal Coliform',
Colonies per 100 ml
Enterococcil,
Colonies per 100 ml
Benchmark
-
100 or SO4
Within 6.0 — 9.0 120
30
1000
500
1
11 hqA0I
/ •
h
tCan. l��tye1
7G2. ���-Gl.
i Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on-site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
"See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ❑ no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No. Sample Collected, Oil and Grease,
mo/dd/yr mg/L
TSS,
mg/L
pH, New Motor Oil Usage,
Standard units Annual average gal/mo
Benchmark - 30
100 or 504
6.0-9.0 -
(if ygS complete Part B)
Only applies to facilities that use/process meats.
'The total precipitation must be recorded using data from an on-site rain gauge.
s For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
'See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
SWU-249 Last Revised: October 18, 2012
' Amman 1 of 7

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES INA ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results for at end of
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
(Signatukd of Perm
.1/3120 5
(date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-249 Last Revised: October 18, 2012
A9(1P % nF7